Quitting smoking after diagnosis of lung, bladder or upper aerodigestive tract (UAT) cancer: Is it supported in primary care and does it improve prognosis?
Amanda Farley, Constantinos Koshiaris and Jason Oke
Presenter(s)
Dr Amanda Farley Lecturer in Epidemiology, University of Birmingham
Abstract
The UK pay-for-performance scheme does not incentivise GPs to address smoking after a diagnosis of cancer, as it does for other chronic diseases. We examined how GPs manage smoking in cancer compared with CHD patients and whether smoking cessation after cancer diagnosis improves prognosis using data from the Clinical Practice Research Datalink (CPRD).
Lung, bladder and UAT cancer cases were matched 1:1 to CHD controls. We used adjusted logistic regression to examine differences in management between cancer and CHD. We compared risk of all-cause mortality and cancer specific mortality between continuing smokers and quitters for each tumour type using multivariable cox regression.
Cancer patients were less likely than CHD patients to have smoking status updated (OR 0.18 95% CI (0.17-0.19)), be advised to quit (OR 0.38(0.36-0.40)), be prescribed treatment (OR 0.67(0.63-0.73)) or to quit (OR 0.76(0.69-0.84)). Quitting smoking significantly decreased the risk of death in lung (HR 0.80(0.73-0.90) and UAT cancer patients (OR 0.71(0.54-0.93)) and also of cancer-specific mortality in lung cancer patients (HR 0.85(0.73-0.98).
Quitting smoking after diagnosis improves prognosis in lung and UAT cancer patients. However, they are less likely to receive help to stop smoking in primary care than CHD patients during the first year after diagnosis.
Source of funding: National Institute of Health Research (NIHR) School for Primary Care Research.
Declaration of interest: The authors have no conflicts of interest to declare.
